Ventilator-Associated Pneumonia in Children After Cardiac Surgery

Abstract

Ventilator-associated pneumonia (VAP) is a nosocomially acquired infection that has a significant burden on intensive care units (ICUs). We investigated the incidence of VAP in children after cardiac surgery and its impact on morbidity and mortality. A prospective cross-sectional review was performed in the postoperative cardiac patients in pediatric cardiac intensive care unit (PCICU) patients from March 2010 until the end of September 2010. The patients were divided into two groups: the VAP group and the non-VAP group, Demographic data and perioperative risk variables were collected for all patients. One hundred thirty-seven patients were recruited, 65 (48%) female and 72 (52%) male. VAP occurred in 9 patients (6.6%). Average body weights in the VAP and non-VAP groups were 5.9 ± 1.24 and 7.3 ± 0.52 kg, respectively. In our PCICU, the mechanical ventilation (MV) use ratio was 26% with a VAP-density rate of 29/1000 ventilator days. Univariate analyses showed that the risk variables to develop VAP are as follows: prolonged cardiopulmonary bypass (CPB) time, use of total parenteral nutrition (TPN), and prolonged ICU stay (p < 0.002 for all). Thirty-three percent of VAP patients had Gram-negative bacilli (GNB). VAP Patients require more MV hours, longer stay, and more inhaled nitric oxide. Mortality in the VAP group was 11% and in the non-VAP group was 0.7 % (p = 0.28). VAP incidence is high in children after cardiac surgery mainly by GNB. VAP increases with longer CPB time, administration of TPN, and longer PCICU stay. VAP increases morbidity in postoperative cardiac patients.

Parenteral Nutrition Is One of the Most Significant Risk Factors for Nosocomial Infections in a Pediatric Cardiac Intensive Care Unit

“…Also, the role of nutrition dosing has been questioned, and untoward effects of early EN were not restricted to patients receiving the highest energy doses 33 . No data are available in the pediatric age, although small studies have suggested that PN is associated with higher ventilator‐associated pneumonia and bloodstream infection 34 …”

Perioperative infections in congenital heart disease

“…Risk factors for ventilator-associated pneumonia were PRISM III score > 10 and transfusion of fresh-frozen plasma. 12 Epidemiology of perioperative infections in low-and middle-income countries Among 21 studies in low-and middle-income countries, four were conducted in China, [43][44][45][46] four in India, [47][48][49][50] three in Brazil, [51][52][53] two in Saudi Arabia 54,55 , and one each in Argentina, 56 Bosnia Herzegovina, 57 Iran, 58 Ethiopia, 59 Guatemala, 60 and Sudan. 61 One multicentre study involving 17 low-to middle-income countries included India, Pakistan, Colombia, Russia, China, Dominican Republic, Brazil, Argentina, El Salvador, Ukraine, Peru, Mexico, Belarus, Vietnam, Uganda, Guatemala, and Bangladesh.…”

“…61 One multicentre study involving 17 low-to middle-income countries included India, Pakistan, Colombia, Russia, China, Dominican Republic, Brazil, Argentina, El Salvador, Ukraine, Peru, Mexico, Belarus, Vietnam, Uganda, Guatemala, and Bangladesh. 62 There were five different study designs including one randomised controlled trial, 53 one non-randomised interventional before-after study, 62 16 cohort studies, [43][44][45][47][48][49][50]52,[54][55][56][57]59,60,63 one case-control study, 51 and three cross-sectional studies. 46,58,61 Most studies were conducted in children, with two in neonates 47,57 and two involving children and adult patients.…”

“…56 The incidence of nosocomial pneumonia approached 21% (67/331) in China to 44% of 6864 children in India 44,49,53 and ventilator-associated pneumonia was 6.2% (105/1688) in China to 18.3% of 160 children in Brazil. 43,53,55 The most common pathogens isolated in children with ventilatorassociated pneumonia were Gram-negative bacilli, followed by Gram-positive cocci and fungi. 43,44,55 Risk factors for ventilator-associated pneumonia included prolonged cardiopulmonary bypass, use of parenteral nutrition, ICU length of stay, 55 mechanical ventilation, extubation failure, emergency surgery, and blood transfusion.…”

“…43,53,55 The most common pathogens isolated in children with ventilatorassociated pneumonia were Gram-negative bacilli, followed by Gram-positive cocci and fungi. 43,44,55 Risk factors for ventilator-associated pneumonia included prolonged cardiopulmonary bypass, use of parenteral nutrition, ICU length of stay, 55 mechanical ventilation, extubation failure, emergency surgery, and blood transfusion. 43 Around 7% children developed catheter-associated urinary tract infections, 49,63 with Gram-negative bacteria most commonly isolated.…”